2023-09-28 14:46:10 +00:00
|
|
|
abstract: 'Objective: We aimed to determine whether gentrification predicts the
|
|
|
|
|
|
|
|
|
|
movement of shooting victims over time and if this process has decreased
|
|
|
|
|
|
|
|
|
|
access to care. Background: Trauma centers remain fixed in space, but
|
|
|
|
|
|
|
|
|
|
the populations they serve do not. Nationally, gentrification has
|
|
|
|
|
|
|
|
|
|
displaced disadvantaged communities most at risk for violent injury,
|
|
|
|
|
|
|
|
|
|
potentially decreasing access to care. This process has not been
|
|
|
|
|
|
|
|
|
|
studied, but an increase of only 1 mile from a trauma center increases
|
|
|
|
|
|
|
|
|
|
shooting mortality up to 22\%. Methods: We performed a cross-sectional
|
|
|
|
|
|
|
|
|
|
study utilizing Philadelphia Police Department (PPD) and Pennsylvania
|
|
|
|
|
|
|
|
|
|
trauma systems outcome (PTOS) data 2006-2018. Shootings were mapped and
|
|
|
|
|
|
|
|
|
|
grouped into census tracts. They were then cross-mapped with
|
|
|
|
|
|
|
|
|
|
gentrification data and hospital location. PPD and PTOS shooting data
|
|
|
|
|
|
|
|
|
|
were compared to ensure patients requiring trauma care were captured.
|
|
|
|
|
|
|
|
|
|
Census tracts with >= 500 residents with income and median home values
|
|
|
|
|
|
|
|
|
|
in the bottom 40th percentile of the metropolitan area were eligible to
|
|
|
|
|
|
|
|
|
|
gentrify. Tracts were gentrified if residents >= 25 with a bachelor''s
|
|
|
|
|
|
|
|
|
|
degree increased and home price increased to the top third in the
|
|
|
|
|
|
|
|
|
|
metropolitan area. Change in distribution of shootings and its relation
|
|
|
|
|
|
|
|
|
|
to gentrification was our primary outcome while proximity of shootings
|
|
|
|
|
|
|
|
|
|
to a trauma center was our secondary outcome. Results: Thirty-two
|
|
|
|
|
|
|
|
|
|
percent (123/379) of eligible tracts gentrified and 31,165 shootings
|
|
|
|
|
|
|
|
|
|
were captured in the PPD database. 9090 (29.2\%) patients meeting trauma
|
|
|
|
|
|
|
|
|
|
criteria were captured in PTOS with an increasing proportion over time.
|
|
|
|
|
|
|
|
|
|
The proportion of shootings within gentrifying tracts significantly
|
|
|
|
|
|
|
|
|
|
dropped 2006-2018 (40\%-35\%, P < 0.001) and increased in
|
|
|
|
|
|
|
|
|
|
non-gentrifying tracts (52\%-57\%, P < 0.001). In evaluation of shooting
|
|
|
|
|
|
|
|
|
|
densities, a predictable redistribution occurred 2006-2018 with incident
|
|
|
|
|
|
|
|
|
|
density decreasing in gentrified areas and increasing in non-gentrified
|
|
|
|
|
|
|
|
|
|
areas. Shootings within 1 mile of a trauma center increased overall, but
|
|
|
|
|
|
|
|
|
|
proportional access decreased in gentrified areas. Conclusions:
|
|
|
|
|
|
|
|
|
|
Shootings in Philadelphia predictably moved out of gentrified areas and
|
|
|
|
|
|
|
|
|
|
concentrated in non-gentrified ones. In this case study of a national
|
|
|
|
|
|
|
|
|
|
crisis, the pattern of change paradoxically resulted in an increased
|
|
|
|
|
|
|
|
|
|
clustering of shootings around trauma centers in non-gentrified areas.
|
|
|
|
|
|
|
|
|
|
Repetition of this work in other cities can guide future resource
|
|
|
|
|
|
|
|
|
|
allocation and be used to improve access to trauma care.'
|
|
|
|
|
affiliation: 'Scantling, D (Corresponding Author), Univ Penn, Dept Surg, Div Traumatol
|
|
|
|
|
Surg Crit Care \& Emergency Surg, Philadelphia, PA 19104 USA.
|
|
|
|
|
|
|
|
|
|
Scantling, Dane; Hatchimonji, Justin; Kaufman, Elinore; Holena, Daniel, Univ Penn,
|
|
|
|
|
Dept Surg, Div Traumatol Surg Crit Care \& Emergency Surg, Philadelphia, PA 19104
|
|
|
|
|
USA.
|
|
|
|
|
|
|
|
|
|
Orji, Whitney, Univ Penn, Perelman Sch Med, Philadelphia, PA 19104 USA.'
|
|
|
|
|
author: Scantling, Dane and Orji, Whitney and Hatchimonji, Justin and Kaufman, Elinore
|
|
|
|
|
and Holena, Daniel
|
|
|
|
|
author-email: Dane.Scantling@PennMedicine.UPenn.edu
|
|
|
|
|
author_list:
|
|
|
|
|
- family: Scantling
|
|
|
|
|
given: Dane
|
|
|
|
|
- family: Orji
|
|
|
|
|
given: Whitney
|
|
|
|
|
- family: Hatchimonji
|
|
|
|
|
given: Justin
|
|
|
|
|
- family: Kaufman
|
|
|
|
|
given: Elinore
|
|
|
|
|
- family: Holena
|
|
|
|
|
given: Daniel
|
|
|
|
|
da: '2023-09-28'
|
|
|
|
|
doi: 10.1097/SLA.0000000000004771
|
|
|
|
|
eissn: 1528-1140
|
|
|
|
|
files: []
|
|
|
|
|
issn: 0003-4932
|
|
|
|
|
journal: ANNALS OF SURGERY
|
|
|
|
|
keywords: access to care; firearm violence; gentrification; trauma centers
|
|
|
|
|
keywords-plus: 'EMERGENCY MEDICAL-SERVICES; SELF-RATED HEALTH; RESIDENTIAL-MOBILITY;
|
|
|
|
|
|
|
|
|
|
INJURED PATIENTS; TRANSPORT TIMES; UNITED-STATES; NEIGHBORHOOD;
|
|
|
|
|
|
|
|
|
|
ASSOCIATION; MORTALITY; OUTCOMES'
|
|
|
|
|
language: English
|
|
|
|
|
month: AUG
|
|
|
|
|
number: '2'
|
|
|
|
|
number-of-cited-references: '45'
|
|
|
|
|
orcid-numbers: Scantling, Dane/0000-0002-0744-9930
|
|
|
|
|
pages: 209-217
|
|
|
|
|
papis_id: 96dea591c2fcd32691833704bbdbc54e
|
|
|
|
|
ref: Scantling2021firearmviolence
|
|
|
|
|
times-cited: '4'
|
|
|
|
|
title: Firearm Violence, Access to Care, and Gentrification A Moving Target for American
|
|
|
|
|
Trauma Systems
|
2023-10-01 08:15:07 +00:00
|
|
|
type: article
|
2023-09-28 14:46:10 +00:00
|
|
|
unique-id: WOS:000670889700022
|
|
|
|
|
usage-count-last-180-days: '1'
|
|
|
|
|
usage-count-since-2013: '6'
|
|
|
|
|
volume: '274'
|
|
|
|
|
web-of-science-categories: Surgery
|
|
|
|
|
year: '2021'
|
